Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic...

Purpose – The purpose of this paper is to discuss the impact of contracts on general practise in the UK National Health Service. In particular, it is concerned with the response of practitioners to the apparent flexibilities offered in the new contract with its focus on outcomes rather than...

Purpose – A recurring theme in Government policy documents has been the need to change the culture of the NHS in order to deliver a service “fit for the twenty‐first century”. However, very little is said about what constitutes “culture” or how this culture change is to be brought...

Purpose – The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new “pay‐for‐performance” contract (the new General Medical Services, or GMS, contract) in general practice. Design/methodology/approach – This article was based on...

Purpose – This paper aims to explore the ways in which practice nurses engage in identity work in the context of chronic disease management in primary care and assess the extent to which this is compatible with the identities promoted in government policy. Design/methodology/approach – The...